Friday, November 14 2008
A few years ago I did a search for scientific studies/papers that investigated or reviewed investigations of cigar smoking and incidence of cancer. I came across some interesting comparative reviews of scientific investigations, although the main problem was that most studies look at cigarettes and not cigars. A couple items of interest that I discovered were: 1) no statistically significant increase in oral cancer can be attributed to the "occasional" cigar smoker [2-3 cigars a week], and 2) there is a statistical increase in certain cancers for prior cigarette smokers that switched to cigars (presumably because they
inhale). It would be interesting to see someone tackle this again, documenting their findings (something I now wish I had done).
- Henry Roberts in California
To answer Henry's question, I tapped one of the most knowledgeable experts in the field, David ("Doc") Diaz, President of Stogie Fresh Online Cigar Publications and founder of StogieFresh.com: - G.K.
This is an interesting and important question. As it turns out, I have been in the health education field for many years and have developed my thoughts on this question.
As Mr. Roberts noted, most studies have been conducted with cigarette smokers and not cigar smokers. Further, most studies are unable to select out those that have been regular cigarette smokers. In other words, they select cigar smokers that have ALSO smoked cigarettes. The best study would select cigar smokers that have never smoked cigarettes. This is a much smaller group. That said, there have been studies that have isolated cigar smokers, cigar/cigarette smokers, and cigarette only smokers, which were then compared with a control group of people who had never smoked.
These studies have found an increased risk for suffering from all types of cancer. However, the key finding was that the degree of risk was roughly proportional to the degree of exposure to the smoke (this was suggested by Mr. Roberts). The studies found a greater risk when the contact between the smoke and the oral mucosa or the contact of the smoke with lung tissue, was increased. There is a "dose-response relationship" between cancer risk and smoking anything, whether cigarettes, cigars, or whatever. That is, the greater the number of cigars smoked per day, the greater the risk. The risk was also increased when cigar smokers self-reported inhaling the smoke.
Thus, the fewer cigars a person smoked per day and the lack of inhaling the smoke, translates into lower risk. Most people could probably see this as a pretty much common sense finding.
My tack has been to translate these findings into generic recommendations. What follows is a transcript below of one of my earliest podcasts on the topic of "Cigars and Health," which looks at the question more generically.
- D.D.
Cigars and Health - What you should know
by David Diaz, Ph.D.
In an increasingly health conscious world, many people want to know how cigars will affect their overall health. In this episode I'll discuss the risks associated with cigar smoking and how you can reduce those risks.
First of all, let's get this straight; cigar smoking is not a healthy activity. Anybody who thinks it is probably missed the day in grade school where the teacher talked about common sense. We don't smoke cigars because they're healthy; we do it because we personally enjoy them, because smoking cigars with friends and acquaintances is a great social activity or celebratory activity and because collecting cigars and their accoutrements can be a fun and interesting hobby. That said, cigar smoking doesn't necessarily have to translate into high risk for morbidity or mortality.
Consider first of all that "health," whatever that may mean, is never static. In other words, you don't suddenly one day achieve health and then never have to worry about it again. Health is always on a sliding scale—it's dynamic. Sometimes you're healthier and sometimes less healthy. The risk of smoking is related to your specific lifestyle practices and especially your pattern of smoking.
Cigar smoking is a lot like eating food and drinking alcohol. The eventual risk of disease is related not only to what you consume, but how much you consume. Eating a hamburger with French fries and a Soda is unlikely to lead to disease. What leads to poor health and eventual disease is eating that same meal every day for 20 years. There is a dose-response relationship between unhealthy practices (or healthy
ones) and disease: the greater the dose, the greater the response. So, while heavy alcohol consumption can give rise to various diseases, moderate alcohol consumption may have no effects, or even beneficial effects on health. Those who smoke 1-2 cigars per day will likely experience lesser negative effects than those who smoke 4-5 cigars per day.
Cigar smoking can be related to coronary artery disease, but moderate cigar smokers that don't inhale and have never smoked cigarettes have been shown to have the same risk or sometimes lower risk of coronary artery disease as their non-smoking counterparts. Also, there are other factors that apart from cigar smoking might be related to the development of heart disease, like family history of heart disease, high cholesterol and other blood fats, high blood pressure, diabetes, and the existence of signs and symptoms related to heart disease. All these risk factors must be taken into account, along with patterns of smoking cigars.
Cigar smoking can cause cancers of the esophagus, larynx, tongue and even lung cancer. However the development of these cancers is in part dependent on other risk factors like family history of cancer, inhalation practices, type of cigars smoked, alcohol consumption and other environmental factors. So, for example, if you have parents or siblings that have suffered from any type of cancer, especially before the age of 50, then your risk for developing cancer is already higher than normal and, in combination with cigar smoking, will also probably be yet higher. Also, if you are a heavy consumer of alcohol, which is a risk factor for various types of diseases including cancer, then combining that activity with cigar smoking can increase your risk.
Nicotine addiction and carbon monoxide poisoning, which are two factors that have been related to cigarette smoking, should also be taken into consideration. However, since carbon monoxide is only absorbed through the lungs, a cigar smoker who does not inhale and who smokes in an environment where they're not inhaling second- hand smoke, will not be effected. Further, nicotine is absorbed largely through the lungs and minimally through the mucous membranes of the mouth. The great majority of moderate cigar smokers, who have never smoked cigarettes, tend not to develop nicotine dependency, nor do they necessarily increase their consumption of cigars over time.
Those of us who smoke cigars would do well to keep the following principles in mind:
1. Don't inhale cigar smoke. Your body was never intended to have you put rolled dried vegetable matter in your mouth, light it, and suck it down inside your lungs for any period of time. So, by not inhaling you substantially reduce the risks.
2. Don't breathe in second-hand cigar smoke. Cigar smoke comes from the incomplete burning of tobacco and is full of harmful chemicals. So, don't smoke in an enclosed room, or if you do, make sure there is adequate ventilation. If possible, smoke outside where the second-hand smoke can be dispersed.
3. If you smoke cigarettes, don't pick up cigar smoking as an alternative. Cigarette smokers tend to inhale reflexively and for the ex-cigarette smoker, cigar smoking may not be a viable alternative.
4. If you are a heavy alcohol user, stay away from all tobacco products. Heavy consumption of alcohol combines with all tobacco products to produce high risk for heart disease and cancer.
Cigar smoking can be a relaxing, social hobby that doesn't have to negatively affect one's health. Though cigar smoking is not without risk, those risks can be managed so that they are acceptable to those who smoke moderately and responsibly. £
For even more interesting reading, including podcasts, cigar reviews, and other valuable information on cigars and cigar smoking, please visit www.stogiefresh.com.
